Those Eyes

My girlfriend's response when I informed her of the role of fungus in seborrheic dermatitis (aka, Dandruff) reeked of incredible disinterest.  "Really?" she asked me, with an incredulously malicious glint in her eye, "that's common knowledge to anyone with a beginner's understanding of hair care."  Despite my argument that this means approximately 1/2 the world's population is completely unaware of this phenomenon, I still had been thoroughly put in my place as late to the scalp health soiree.  She regaled me with a robust explanation of why dandruff shampoo included selenium, an active ingredient that disrupts fungal cell cycles.  She lambasted my poor understanding of how to keep a scalp healthy and flake free.   She gave me the treatment that I usually reserve for all my otherwise intelligent friends when it comes to healthcare. All this she did with a look in her eye, a patient but condescending look that I imagine I wear all the time.   Man, do I hate that look. 

The long and short of the facts of dandruff is that it results from a persistent fungal skin infection causing seborrheic dermatitis, a fatty flaky rash that generates the pseudosnow dappling some of our dark shirts and jackets.  The shampoo's and medications used to get rid of it are all antifungal in their function, and the one real take away message is that you need to rotate your antifungal shampoo in order to fully clear a fungal infection, as they will grow tolerant to monotherapy with head and shoulders (active ingredient: selenium). 

But I knew none of this.  It wasn't covered in my pathology class. I had heard of seborrheic dermatitis, but only in connection to HIV (which increases the incidence, as if HIV patients needed the insult of dandruff on top of the injury of HIV).  We don't educate well on the annoyances, the minor medical mysteries and problems that confound people on a day to day basis.  You pick that up in residency, in practice.  On that fateful day my girlfriend taught me two lessons.  First, a strong preliminary course in haircare.  Second, a lesson in humility.  Next time I give a patient or a friend a lecture, it will definitely come from a place of better understanding.